NOTICE OF INTENT TO HOMESCHOOL
NOTICE OF INTENT TO HOMESCHOOL
We the undersigned parents and/or guardians do hereby serve notice to the superintendent of School District – XXXX Public Schools that we have established and are in charge and control of a non-public home-based educational program pursuant to CRS 22-33-104.5 for the 2012-2013 school year, beginning Month XX, 2012.
(School Year) (Date)
Child’s Name Child’s Age Attendance
| | |4hrs/day, 172 days/yr |
| | |4hrs/day, 172 days/yr |
| | |4hrs/day, 172 days/yr |
| | | |
| | | |
| | | |
| | | |
All children listed above currently reside at:
(Street Address Goes here)
The test or evaluation results of our children will be submitted to:
XXX Public School District when they are tested or evaluated upon completion of grades three, five, seven, nine, and eleven.
Signatures:
__________________________________ Date: _______________
__________________________________ Date: _______________
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